“Don’t ask, don’t tell” is how many veterans have approached health-care conversations about marijuana use with the doctors they see from the Department of Veterans Affairs.

Worried that owning up to using the drug could jeopardize their VA benefits — even if they’re participating in a medical marijuana program approved by their state — veterans have often kept mum. That may change under a new directive from the Veterans Health Administration urging vets and their physicians to open up on the subject.

The new guidance directs VA clinical staff and pharmacists to discuss with veterans how medical marijuana could interact with other medications or aspects of their care, including treatment for pain management or post-traumatic stress disorder.

The directive leaves in place a key prohibition: VA providers are still not permitted to suggest veterans try state-approved medical marijuana programs, because the drug is illegal under federal law.

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That disconnect makes veterans wary, said Michael Krawitz, a disabled Air Force veteran in Ironto, Va., who takes oxycodone and marijuana to treat extensive injuries he suffered in a motorcycle accident while stationed in Guam in 1984.

“Vets are happy that there’s a policy, but they’re unnerved by that prohibition,” he said.

Krawitz, 55, is executive director of Veterans for Medical Cannabis Access. He has always been open with his VA doctors about using medical marijuana and hasn’t suffered negative consequences. But Krawitz said he has worked with veterans who were kicked out of their VA pain management program after a positive drug test and told they couldn’t continue until they stopped using cannabis.

Such actions are usually misunderstandings that can be corrected, he said, but he suggests that the Veterans Health Administration should provide clear guidance to its staff about the new directive so veterans aren’t harmed.

Although the new guidance encourages communication about veterans’ use of marijuana, the agency’s position on the drug hasn’t changed, said Curtis Cashour, a VA spokesman.

Cashour referred to Veterans Affairs Secretary David Shulkin’s statement at the White House in May that he thought in “some of the states that have put in appropriate controls (on medical marijuana), there may be some evidence that this is beginning to be helpful. And we’re interested in looking at that and learning from that.” But until federal law changes, the secretary said, the VA is not “able to prescribe medical marijuana.”

Cashour declined to provide further information about the new directive.

Federal law classifies marijuana is a Schedule I drug, meaning it has no accepted medical use and a high potential for abuse. Heroin and LSD also are Schedule I drugs. Doctors aren’t free to prescribe marijuana. But in states that have legalized medical marijuana, doctors may refer patients to state-approved programs in certain circumstances. (Doctors can, however, prescribe three drugs approved by the Food and Drug Administration that are made of or are similar to a synthetic form of THC, a chemical in marijuana.)

Twenty-nine states and the District of Columbia have laws that allow people to use marijuana for medical purposes. Patients with a condition approved for treatment with marijuana under these laws are generally registered with the state and receive marijuana through state-regulated dispensaries or other facilities.

Moves by states to legalize marijuana have created a confusing landscape for patients. Attorney General Jeff Sessions in January rescinded an Obama-era policy discouraging federal prosecution for marijuana use in states where it is legal. That has further clouded the issue.

Some consider caution a good thing. The accelerating trend of states approving marijuana for medical and recreational purposes may be getting ahead of the science to support it, they say.

A report released last January by the National Academies of Sciences, Engineering and Medicine examined more than 10,000 scientific abstracts about the health effects of marijuana and its chemical compounds. The experts found conclusive evidence for a relatively limited number of conditions, including relief of chronic pain, nausea and vomiting associated with chemotherapy, and of muscle spasms associated with multiple sclerosis.

“I believe that there are chemicals in marijuana that have medicinal properties,” said Otis Brawley, chief medical officer at the American Cancer Society. “I would love to know what those are, what their medicinal properties are and what the dose should be.” But, he said, studies are extremely challenging because of restrictions in the United States on conducting research on Schedule I drugs.

No matter where the research stands, getting a complete medication or drug history should be standard procedure at any medical appointment, say medical providers.

In that respect, the guidance from the VA is a positive development.

“It’s absolutely critical that you know what your patients are taking, if only to be better able to assess what is going on,” said J. Michael Bostwick, a psychiatrist at the Mayo Clinic in Rochester, Minn., who has written on medical marijuana use.